Scoliosis may first be suspected when one shoulder seems higher than the other or when clothes do not hang straight, but it is often detected during routine physical examination. Other findings include apparent leg-length discrepancy and asymmetry of the chest wall. Patients may initially report fatigue in the lumbar region after prolonged sitting or standing. Muscular backaches in areas of strain (eg, in the lumbosacral angle) may follow.

The curve is most pronounced when patients bend forward. Most curves are convex to the right in the thoracic area and to the left in the lumbar area, so that the right shoulder is higher than the left. X-ray examination should include standing anteroposterior and lateral views of the spine.

The greater the curve, the greater the likelihood that it will progress after the skeleton matures. Curves > 10° are considered significant. Prognosis depends on site and severity of the curve and age at symptom onset. Significant intervention is required in < 10% of patients.

Prompt referral to an orthopedist is indicated when progression is of concern or the curve is significant. Likelihood of progression is greatest around puberty. Moderate curves (20 to 40°) are treated conservatively (eg, physical therapy and bracing) to prevent further deformity.

Severe curves (> 40°) may be ameliorated surgically (eg, spinal fusion with rod placement).

Scoliosis and its treatment often interfere with an adolescent’s self-image and self-esteem. Counseling or psychotherapy may be needed.